Peptic ulcer disease: symptoms, causes, treatments

Peptic ulcers are open sores that form in the lining of your stomach or intestines that can cause pain, bloating, nausea, or other gastrointestinal symptoms. If you have one or more of these ulcers, this condition is called peptic ulcer disease (Lanas, 2017).

If you’re dealing with this uncomfortable and often disruptive condition, you want answers. This article will help you understand peptic ulcer disease and what you can do about it. 

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The wall of your stomach is lined with a layer of mucus. This mucus protects the cells and tissues from getting damaged by the harsh digestive acids that break down the foods you eat.

Peptic ulcers are injuries—sores—in the lining of the stomach or intestines that result from a breakdown in this mucus layer. This breakdown allows those digestive acids to damage the underlying cells or tissues (Kuna, 2019).  

Peptic ulcers are usually described as either gastric ulcers (those that form in the stomach) or duodenal ulcers (those that form in the duodenum, which is the first part of the small intestine) (Lanas, 2017). 

While not everyone experiences symptoms with peptic ulcer disease (a phenomenon known as silent peptic ulcer disease), when symptoms are present, they are usually related to the damage to the lining of the stomach or small intestine and may include (Lu, 2004; Malik, 2021):

• Stomach or abdominal pain

• Bloating

• A feeling of abdominal fullness (even without having eaten a large meal)

• Unexplained weight loss or weight gain

• Blood in stool or vomit 

• Nausea or vomiting

The location of an ulcer can change its symptoms. For example, nighttime abdominal pain is more common in people with ulcers in their intestines. Meanwhile, stomach ulcers are more likely to cause nausea, vomiting, or pain right after eating (Lanas, 2017).

It’s important to note that these symptoms are also typical of other GI disorders, including GERD (gastroesophageal reflux disease), gastritis (stomach inflammation), dyspepsia (indigestion), and colon cancer. So, if you’re experiencing one or more of these symptoms, this isn’t a sure sign of peptic ulcer disease. You should see a healthcare provider who can perform tests (blood tests, endoscopy, biopsy, etc.) to determine if ulcers are present (Lanas, 2017). 

Your digestive tract is coated with a protective layer of mucus that normally shield the stomach wall against acid. Ulcers develop when too much stomach acid in your GI tract destroys this layer. 

With time, the acid eats away at the mucus layer in your upper GI tract and the cells underneath, causing injuries to the underlying tissues (Kuna, 2019).

The disease is tied to several risk factors. Bacterial infection and the use of some over-the-counter (OTC) medications top the list. 

H. pylori infection

Helicobacter pylori (H. pylori) is a common type of bacteria that infects up to 30–40% of people in developed countries. While it’s not exactly clear how H. pylori is transmitted, experts believe people catch it through personal contact—kissing, sex, sharing the same utensils—or via poor personal hygiene practices or contaminated food (Hooi, 2017; Perry, 2006).  

The bacteria set up shop in your stomach. It is believed that it causes an immune response, shifts the pH balance of your stomach juices, interferes with the secretion of digestion-related hormones, and causes other problems closely linked with the development of ulcers (Kuna, 2019). According to some estimates, this bacteria is linked to  90% of ulcers in the small intestine, and 70% to 90% of gastric ulcers (Malik, 2021).

OTC medication use

Using non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen) regularly is a significant risk factor for peptic ulcer disease. That doesn’t mean that you’ll automatically develop an ulcer when you take these drugs, and most people who take these drugs do not develop ulcers. For example, taking NSAIDs for a short period of time (less than one week) is unlikely to harm your stomach. But studies have shown that complications from these drugs are most common within the first three months after starting them, and they can even happen when you take low doses of aspirin (Rodríguez, 2011).  

It’s not entirely clear how these drugs cause or contribute to peptic ulcer disease. Some research has found that NSAIDs may change how certain cells in the lining of the GI tract function. Also, the risk for ulcers seems to be greater in people on NSAIDs who are also taking other drugs, such as steroids or anticoagulants (Kuna, 2019). Meanwhile, some research has linked aspirin to mucosal damage, which may promote ulcers (Lanas, 2017).

Other risk factors

Aside from H. pylori and OTC medications, some other risk factors for peptic ulcer disease include (Sverdén, 2019):

• Cigarette smoking

• Past gastric bypass surgery

• Autoimmune diseases, such as Crohn’s disease

• History of certain infections, such as syphilis

• Stress associated with serious trauma

People used to think that everyday stress could cause ulcers. But researchers haven’t found a lot of evidence to support these theories. Some research has linked alcohol consumption, everyday stress, and coffee consumption to peptic ulcers, but these links aren’t conclusive (Sverdén, 2019).

Treatment for peptic ulcer disease involves acid-lowering measures, including medications and steps to reduce or eliminate relevant risk factors. In the case of an H. pylori infection, this usually means taking an antibiotic. 

If your healthcare provider determines that NSAIDs or aspirin contribute to your ulcers, you may have to stop using these medications. There are similar drugs that do not promote ulcers, and you may be able to switch to one of those. 

Some people with peptic ulcer disease require surgery to remove or repair their ulcers. This is more common in people with other health issues, such as gastric cancer (Malik, 2021). 

Peptic ulcer disease medications

Proton pump inhibitors (PPIs) are drugs that decrease acid production in the stomach (Ahmed, 2021). These are one of the most common drugs for treating peptic ulcers. They can help ulcers heal and prevent new ulcers from forming.  

If you’re infected by H. pylori, your healthcare provider may prescribe you a number of different antibiotics. Because of antibiotic resistance—the emergence of new bacteria types that are resistant to these drugs—you may need to take a combination of several antibiotics (Sverdén, 2019).

Approximately 60% of peptic ulcers heal spontaneously, meaning they go away on their own. The risk of complications from ulcers is relatively low: 2–3 % of people with chronic peptic ulcer disease have complications (Leodolter, 2001). The risk of complications for people with ulcers has been decreasing across the population, thanks to treating H. pylori infections and widespread use of proton pump inhibitors.

Complications of ulcers can include: 

• Internal bleeding that may require hospitalization or a blood transfusion is the most common complication of peptic ulcers in the US. One sign of severe blood loss is black or bloody vomit or black or bloody stools.

• A hole in the wall of your stomach

• Blocking the passage of food through the digestive tract

Bottom line: peptic ulcer disease is a common but often manageable condition. 

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Current version

March 23, 2022

Written by

Health Guide Team

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.